Healthcare Provider Details

I. General information

NPI: 1174658280
Provider Name (Legal Business Name): INDIANA PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 N SHADELAND AVE SUITE 290
INDIANAPOLIS IN
46250-2070
US

IV. Provider business mailing address

7301 E 90TH ST SUITE 112
INDIANAPOLIS IN
46256-7206
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-7990
  • Fax: 317-841-8253
Mailing address:
  • Phone: 317-565-1411
  • Fax: 317-773-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000701A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SCOTT L SCHULMAN
Title or Position: PRES OWNER
Credential: DPM
Phone: 317-841-7990